Court Victory for Independent Medicine in Fight for Site-Neutral Payments

July 17, 2020
As you may recall from a previous communication sent earlier this year, LUGPA and two other stakeholders filed an amicus curiae brief  in the United States Court of Appeals for the District of Columbia in support of the HHS Secretary’s action to cap rates for hospital clinic visit services in the off-campus outpatient department setting.  In AHA vs. Azar, plaintiff hospitals challenged a CMS policy which applied a site neutrality policy to payments for outpatient services that were performed in an off-campus department of a hospital and were paid under the Outpatient Prospective Payment System (OPPS) rather than the physician fee schedule (PFS).

Today, the court has unanimously reversed a district court decision that had determined the rate change in the 2019 OPPS was outside of HHS authority.  In the opinion for the Court filed by Chief Judge Srinivasan, the Court concluded that the regulation rests on a reasonable interpretation of HHS’s statutory authority to adopt volume-control methods.  With today’s decision, the DC Circuit has supported CMS’ authority to adjust payments under the OPPS system in response to perceived reimbursement dynamics that unnecessarily increase volume of service. 

While the hospital plaintiffs may file an appeal, today’s decision is a big win for independent practices that provide services to Medicare patients to level the playing field.  LUGPA continues as the leading advocate on behalf of independent urology groups and has long recognized that payment disparities across different sites of service hurts patients and physicians in independent practices.  

"We are pleased that LUGPA’s health policy efforts in supporting HHS to level the playing field between hospitals and independent practices has been supported by today’s court decision," said LUGPA President Richard Harris, MD.  "With our members’ support, we will continue to fight for the rights of independent physicians."

Read the full decision on the LUGPA website.